mechanical ventilation - APRV 2

aprv

Category:

Education

Tags:

• abg
• nurse
• respiratory
• assessment
• ventilation

[ManoyTKO]

@danielfm2 read dr habashi's evidence-based papers and he cites numerous studies on the benefits of aprv. data is not there for HFOV and ECMO. Tobin's report is one study. In a court of law the evidence supporting aprv is strong. Tobin, though credited for SBT/RSBI, is only one opinion. Careful how you knock aprv as this is a promising mode. I think most people need to be more comfortable with the mode before we criticize.

[gblespaul]

One thing you have to understand is that you want the patient to be able to breathe spontaneously, that is how you determine if you will use pcirv or aprv. In pcirv the patient is not allowed to breath spontaneously at upper peep level. In aprv active exhalation valve allows this. To sedate a patient that does not need to be is a mistake. I have read many articles over the last 20 years. If you know how to read all graphics technically any patient can be ventilated in aprv.

[danielfm2]

Some articles comparing APRV with SIMV... (yes I know that is stupid), there's no article comparing APRV with ARDSnetwork, VAFO, prone position. For Amato high peep are need to mantain reclutated lung. So high levels of peep are useful onky for reclutable patient, and had to be program with the best compliance.

[danielfm2]

APRV do not improve anything, several adult patients treated with APRV had to change the ventilator support to Pressure control ventilation, prone position, VAFO or even ECLS. The articles cited are only on less severe ARDS, trauma. Please read the chapter on Martin Tobin's mechanical ventilation book, and you realised that APRV is not so good.

[bdictjames]

Thanks for posting this.

[o5raul]

you are right,but its depeend on the disease

in neonates we see too much complication secondary to wrong high levels of PEEP

[elirondon]

please correct me if I'm wrong but I think that higher levels of peep doesn't improve survival. Also,I'm not aware of any dobleblind, control study comparing APRV vs AC that show impruving survival . Thanks.